Provider Demographics
NPI:1699516245
Name:GERHAM, ALEXA MARIE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARIE
Last Name:GERHAM
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1943 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7982
Mailing Address - Country:US
Mailing Address - Phone:516-477-3490
Mailing Address - Fax:
Practice Address - Street 1:1943 PIERCE ST
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7982
Practice Address - Country:US
Practice Address - Phone:516-477-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029199225X00000X
SC7364225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist